There are a number of drugs that reduce intra-ocular pressure by various mechanisms, with a topical beta-blocker or prostaglandin being first choice treatment options. If glaucoma progresses or intra-ocular pressure cannot be reduced sufficiently consider an alternative class of topical treatment or a combination of drug classes.

Understanding quantity required:

There are 20 drops in 1ml of medication. Therefore a 5 ml bottle has 100 doses.

One drop is sufficient for one dose and contains more volume than the eye can hold. Closing the eye and pressing on the tear duct for 1 minute can deliver 50% improved absorption of active ingredient. A patient should wait 5 minutes between different eye medications.

Because prostaglandins (Latanoprost / bimatoprost / tafluprost / travoprost) are administered once daily, bottles are only 2.5ml or 3ml

Glaucoma | Pathway for non-surgical management

Tablets and MR capsules - Used when IOP uncontrolled on maximum tolerated topical treatment
Injection - Primary acute angle closure. Open and narrow angle glaucoma

Pack
28 capsule
30 capsule
20 capsule
Pack
112 tablet
120 tablet
100 tablet
Pack
1 vial

Bimatoprost 300mcg/ml eye drops preservative free (multidose container) is the preferred choice for newly initiated patients

Bimatoprost 100mcg/ml eye drops is second line

The brand Bimi® (Bimatoprost 300mcg/ml eye drops preservative free (multidose container)) shelf life extended to 90 days

 

Pack
3 ml
9 ml
Pack
3 ml
9 ml
Pack
30 unit dose
Pack
3 ml
9 ml

2nd choice - to be considered where there is intolerance to dorzolamide or it has not been effective.
Administration twice a day

Pack
5 ml

Second line treatment as per NICE guidelines

Pack
5 ml

Usual administration:

Three times a day (mono therapy)
Twice a day (dual therapy with topical beta-blocker)

Dorzolamide 20mg/ml eye drops preservative free are more cost effective than preservative free 0.2ml unit dose drops

Pack
5 ml
Pack
60 unit dose
Pack
5 ml

Dorzolamide 20mg/ml / timolol 5mg/ml eye drops preservative free 5ml and 10ml bottles are the preferred choice for newly initiated patient.

Cosopt iMulti is not recommended as it is not cost-effective

Pack
5 ml
Pack
60 unit dose
Pack
5 ml
10 ml

1st line choice
Administration once a day (evening)

Pack
3 ml
Pack
30 unit dose
90 unit dose

Reserved for patients with preservative allergy where latanoprost and travoprost have already been tried
Apply once a day, preferably in the evening

Pack
30 unit dose